Solving the Opioid Crisis: How do Opioids Work?

The University of Michigan is teaming up with Coursera to create Teach-Outs which are week-long MOOC lecture series which address problems currently faced in society today. The following are notes for lecture set 3 of Solving the Opioid Crisis.

This lecture was given by Daniel Clauw, Professor of Anesthesiology, Medicine (Rheumatology) and Psychiatry at the University of Michigan. He serves as Director of the Chronic Pain and Fatigue Research Center. Until January 2009 he also served as the first Associate Dean for Clinical and Translational Research within the University of Michigan Medical School, and PI of the UM Clinical and Translational Sciences Award (CTSA).

People are mainly focused on the deaths by overdose due to opioids, but another aspect of the epidemic is that many people are on opioids long term due to chronic pain. This is not a good use of opioids, since they do not target many forms of chronic pain, so doctors are no longer prescribing them (as often) for this purpose. Chronic pain that is located in a certain body part (such as in osteoarthritis) can be helped by a small dose of opioids, but pain originates in the nervous system (like fibromyalgia) is not helped by opioids.

Opioids bind the same receptors as endorphins, so when people are given opioids their endorphin systems are being hijacked. When someone has been on opioids for years, it is difficult to take them off because they no longer have a normally functioning endorphin system. There should be two sets of rules for prescribing opioids: those for people who have been on opioids chronically and those who are newly starting with a pain control regimen.

Until the 1990s, people who died of opioid overdose were heroine addicts that started on heroine. They were lower socioeconomic class, inner city, and black. Therefore, it wasn’t considered a major problem by the privileged classes. However, in the 90’s, doctors started over-prescribing opioids so that now, 60 to 70 percent of people who die of opioid overdose started with a prescription. That’s something the privileged majority is willing to pay attention to.

This lecture came with the following discussion question: Dan Clauw mentions the pharmaceutical industry’s argument that access to opioids are “a human right”. Do you agree with this sentiment? If so, why? If not, why?

I believe that healthcare and access to proper medications is a human right. However, I do not believe that there is a human right to be pain-free. If the risks of giving opioids outweighs the benefits, then opioids should not be prescribed.